Provider Demographics
NPI:1790780369
Name:BATEMAN, JOHN EUGENE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EUGENE
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 8TH AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:PLATTSMOUTH
Mailing Address - State:NE
Mailing Address - Zip Code:68048-2367
Mailing Address - Country:US
Mailing Address - Phone:402-296-2200
Mailing Address - Fax:402-296-6055
Practice Address - Street 1:2380 8TH AVE
Practice Address - Street 2:STE 4
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2367
Practice Address - Country:US
Practice Address - Phone:402-296-2200
Practice Address - Fax:402-296-6055
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-10-02
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NE911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470743194-00Medicaid
NE470743194-00Medicaid
NE089837Medicare ID - Type UnspecifiedMEDICARE